Why are the NHS making access to 'fat jabs' almost impossible.

[thefishingboatbobbingsea]

I cannot get my head around why the GPs are not being encouraged to prescribe the new weight-loss injections such as Mounjaro (MJ) . Instead, this NICE approved medication is only available via the NHS Tier 3 pathway for weight-loss .

I went down this road 4 years ago It is mostly a complete waste of time and smacks of making the 'fat people jump through hoops ' as a punishment for getting in that state to begin with.

Tier 3 for me , consisted of waiting 8 months for the referral appointment, driving an 86 mile round trip to the only hospital in the area with an obesity clinic. (Lucky I drive otherwise it's over 6 hours on the train).
Then being weighed. Then sitting in a 'workshop' where we are given amazing revelations such as (promise this is true) a pork pie has more calories in it than an omelette, that processed sugar laden food is worse for you than salad. That protein keeps you feeling fuller than a doughnut...(I can only assume that the NHS believe that old stereotype of Fat=Stupid. )

You have to do that every 6 weeks for about 9 months before you are eligible to go forward for your conversion with the surgical team to discuss the option of gastric sleeve, or gastric bypass. (Tier 4) then wait a further 6 months for the surgery.

I jumped through these hoops and had my surgery. I had gone from 19st to 21st while waiting to go /being on Tier 3/4.. so a complete waste of NHS time, my time and everyone's effort. Not to mention the massive cost of all the salaries of receptionist, nurses, dieticians involved.

I lost 7 stone. Which was obviously great . The difference in my health was astounding. Before surgery I was on medication for high blood pressure. A statin, metformin (type 2 diabetes) cortisone injections for painful knees. Thyroxine and associated clinics and monitoring.

Post surgery I am no longer diabetic. Have no knee problems. BP no longer high and the only medication I still take is Thyroxine. I was still 3stone 4lbs overweight. I go to the gym 5 days a week, I eat healthily, but I was only maintaining not losing. Probably due to being post menopausal.

However I am acutely aware of the health issues associated with obesity. (I was still obese with a BMI of 31 from 44 at my heaviest) and decided to investigate the new range of weight loss jabs. I settled on Mounjaro and am 19lbs down in 9 weeks. It's such an amazing tool for weight loss.

So my question is this. Given that obesity is the greatest single cost to the NHS why on earth are they not making MJ or Ozempic available from a GP. ? rather than the long winded and entirely pointless 'tier3 tier 4' nonsense. ?

Why is it that the wealthy are able to lose weight successfully without 'workshops' telling them that Pork pies are more unhealthy than omelettes. ? Or is it just an extension of that fat = stupid stereotype.. to poor=fat=stupid ?

AIBU fat loss jabs should not be available via the GP.

YANBU fat loss jabs work. The NHS will save a lot of money with fewer people suffering obesity related diseases. The benefit will far outweigh the cost.

Do you think they are not shit scared too? Shit scared of the state they are in, health issues they have today and what the future holds, but they can't loosen the grip food has on them. You can't be expected to understand if you haven't lived it but surely it gives you an indication of how difficult a problem it is for them if they are still trying even with those side effects and risks?

They are not taking the injections for fun or as an easy way out. They are taking them as a last resort.

After the weight loss, most people look ill.

Injections or not, after decades of obesity, there are going to be issues with lose, sagging skin and wrinkles for many, including on the face. Should they just stay fat instead? Then get told they are disgusting and lazy? Can't win! To be honest I don't care how you think I look, I am trying to do something to improve my health.

Phentermine 37.2 mg, but I have 17.1mg as well. There's risks and side effects, but they work for me and have helped me do intermittent fasting and help me with energy levels. I just made the decision that jabs wouldn't be the answer for me and I can see why the NHS is holding back in the case of those around 15 stone and under.

Fuck me.
Someone asked me what was all the "degrading" stuff for human beings.
I answered honestly after seeing some side effects regarding my relatives.
It seems there is no win with people "interested"
in this treatment, either.

For those saying the drug has been approved and therefore it must be safe would do well to keep an eye on emerging research. Clinical trials do not always produce real world data.

https://www.cnn.com/2023/10/05/health/weight-loss-drugs-serious-digestive-problems-study/index.html

The researchers note that these problems probably didn’t show up in the clinical trials that led to the drugs approval because those studies weren’t large enough to capture some of these rarer adverse events, or the studies recorded these events as symptoms, rather than delving their underlying causes

The long term side effects will only start to emerge a few years down the line. The big pharmas will defend the products because they are making a fortune.

Why are those side effects especially "degrading"? Your relatives had side effects that they personally found degrading, perhaps. You can't generalise to everyone else, and the vast majority of people have no or minimal side effects.

@MacDonaldandHobNobs I'm not saying that it must be safe, I'm saying that risks of serious side effects are demonstrably extremely low. The report described in that article is worth bearing in mind of course but it has limitations and weaknesses. More research should of course be carried out. If risks are shown to be unacceptably high then of course these types of medications should be restricted or stopped.

It is also worth remembering that being obese, particularly those with severe, morbid or extreme obesity, is in itself risky and associated with serious side effects. And of course the associated impact on well-being.

I don’t know the answers to your questions off hand, but read the NICE guidelines and associated documents if you’re unclear. NICE committees are very transparent about their recommendations, which are based on all available evidence.

The doctor in the Zoe podcast I mentioned above views obesity as a disease and that once significant weight gain happens it is extremely difficult to maintain long term weight loss. He says after dieting or coming off the fat loss injections your body will be fighting to get back to its set point at the weight you were through increasing hunger hormones and suppressing satiating hormones. From the transcript,

“The brain has a set point of where it believes you’re weight ought to be. That gets back to that whole famine and starvation concept I talked about before. So the body doesn't forget. It's under the category of unfair. But the body, the brain doesn't quite forget where you started, and it works its way very slowly over one to probably five years to get you back to where you were. Now you can introduce change in your diet. Again, reduce calories, and increase physical activity. Drive the body weight down again. But again, over time it's likely to go up. We see this in animal studies all the time. We change the rat chow. We change how many times, they're on the treadmill and the rats go back to the weight that they started at.

And we are biological beings, and our bodies behave in very similar ways. There are only two interventions that I am aware of. That changed this set point of where the brain thinks you ought to be. One is medications. We're talking about that today. The other is bariatric surgery.

It’s worth reading the transcript for full details. https://zoe.com/learn/podcast-can-ozempic-semaglutide-solve-weight-loss

Only a third of people take these drugs for more than a year

https://www.healthline.com/health-news/most-people-top-using-ozempic-wegovy-after-a-year-experts-explain-why#Takeaway

I mean I wouldn't die without my meds but they're essential and lifelong. And also expensive, Xolair is about £250 per injection to the NHS I think and I have 2 every 4 weeks

Xolair - means I can exercise, wear a coat, walk, have a hot bath. Without it I can basically sit on the sofa and not move which creates it's own issues
GCSF - raises my neutrophils so I don't get constant infections, higher risk of sepsis if I do get an infection
Antihistamines 4 x daily to back up the Xolair. Have a prescription as the sheer amount means it's hard to buy without questions

My DH is autistic. Food has been diagnosed as an obsession by a psychiatrist and psychologist and confirmed he will not be able to lose weight by any standard route. He has tried and failed a million times.
he costs the nhs a fortune. His knees are gone, he’s diabetic etc etc. For someone like him that jab would be invaluable and would save the nhs a lot of money.
He was told all weight loss services in our part of the country have been shut, let alone any kind of access to the jab.

I eat the same food I ate when I was slim. Healthy vegetarian food. I don't think I need to change the food I eat at all.

But again, you're overweight, go to seek help but instead of thinking "ill eat better and go for a walk" you put on 3 stones "waiting for the referral" and now you say you can afford the injection.

It reads as though you couldn't be bothered to try because you were waiting for someone else to answer your problem when in fact, you could have just gone private and paid before putting on the extra 3 stones. This is why people think fat people are stupid. You put on 3 stones whilst waiting to be helped to lose weight.

But again, what happens when you stop taking the injection? Have you learnt enough about yourself to keep you on track?

I have to say I took Orlistat at one point. I heard scare stories about that causing diarrhoea. It didn't do that for me. It did nothing! Didn't lose any weight!

That does sound scary, though, I agree.

Write to your MP. Start a petition.

What would you like GPs to stop doing, in order to have the time to do this? @thefishingboatbobbingsea

That is very interesting @Zotter. Similar to the information in the Dr Andrew Jenkinson book 'Why We Eat Too Much'. I have to confess that, until I read that book, I was a bit ignorant about obesity and wondered why people didn't just use determination and willpower to stop eating so much. Just make better choices. But it's not that simple. I have definitely altered my thinking and my attitude.

I said more people. I know there are people why have tried doggedly to lose weight the natural ways and it doesn’t come off or stay off. But making it too easily available would result in people who haven’t tried losing weight by exercise and dietary changes also seeking it out.

Long term ‘fat jab’ user here 🖐
Oz, Wegovy then MJ for over a year and been off for 6+ months.
Typical stereotype - I ate crap, didn’t exercise. Was addicted to sugar and UPFs.
Paid privately for Wegovy & MJ after Oz dried up via GP. Been offered MJ since via GP but I declined.
i have maintained my weight loss. The difference being that my sugar addiction was broken for longer than a month, the messages my body was giving to my brain or vice versa allowed me an opportunity to think and feel differently, i lowered my weight point and simply cannot overeat anymore. These jabs are a life changer. If you’ve been in an obese category for your entire life, getting to a healthy BMI is so transformational mentally and physically, I cannot see myself being overweight again. I’m not the same person. This is the same for everyone in my group - no one has regained more than 4lb over 6 months. Many have continued to lose naturally. Not to mention the disappearance of the majority of other ailments people had. Having an opportunity to be healthy in so many ways, for the first time in most peoples adult lives is the key to these jabs.
But I agree, it’s being misused. I see so many more side effects popping up but they seem to be from the still eating crap but I have 10lb to lose for a holiday brigade. Personally I had minimal side effects apart from change in menstrual cycle which is widely reported and advised upon. Very similar in the group too nothing frightening, all long term users and long term maintainers post the jab.
i recently declined the GP offer of MJ as it came with ‘your ideal weight is 7st 13lb’. I instead pay for private healthcare now (1/3 of the price of MJ monthly) as the advice and support has been fantastic. I still get a monthly check in and we’ve agreed that 9st (now size 8-10) is my happy weight. Jesus if I dropped another stone, I’m sure I’d be ill. For context by BMI is still 29 as I’m super short but I have huge boobs which never got any smaller (must be genetics!). But GP won’t take that into account. They actually called me in to ask me if I wanted it & I said I’d already been on it and was happy with the current weight and they said I should be thinner!
anyway I digress, it has to be cheaper in the long run for the NHS. And for people saying you will still eat crap, you absolutely cannot (if you do, you’ll get the side effects) and once you’ve lowered your weight point and changed your brain, you absolutely don’t want to, even with no jab.

There is no answer @thefishingboatbobbingsea could give to that loaded question that would satisfy your disdain for "lazy, fat people". We all have our own opinions on NHS services and how they should be prioritised and some that should be scrapped.

Obesity is a complex health condition which is as worthy of NHS support and treatment as all the other services they provide.

Supply issues for one.
Funding for another.
Bit of a hands-tied situation really- we're supposed to refer to weight management clinics for this- it really needs support and monitoring- not something that can be done in a 10 min GP appointment- but clinics are closed due to overwhelming demand.

It's not a loaded question. I'm a GP. I think these should be much more widely available. But 'get the GP to do it' with no extra resources, is not the answer - we have no free time.

That's a fascinating account, @SofieM0, thank you. What is the private healthcare you're having?

Obesity is a national health crisis which needs tackling.

It is the responsibility of the NHS to work out how to best fund and resource it nationally.

@SofieM0 thank you. That was great to read and really encouraging for people on the jabs currently and worried about maintenance.